British Journal of Radiology最新文献

{"title":"Randomized clinical trial on accelerated preoperative hyperfractionated radiotherapy versus preoperative hyperfractionated radio-chemotherapy in locally advanced rectal cancer.","authors":"Adam Idasiak, Barbara Ziółkowska, Marcin Rajczykowski, Katarzyna Galwas, Iwona Dębosz-Suwińska, Marcin Zeman, Jolanta Mrochem-Kwarciak, Rafał Suwiński","doi":"10.1093/bjr/tqae176","DOIUrl":"10.1093/bjr/tqae176","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare pathological response rates after preoperative hyperfractionated radiotherapy with co-administration of chemotherapy based on 5FU (HART-CT) versus preoperative hyperfractionated radiotherapy (HART) in patients with resectable rectal cancer.</p><p><strong>Methods: </strong>Patients with T2/N+ or T3/any N rectal cancer were randomized either to HART twice a day (28 fractions of 1.5 Gy) to total dose 42 Gy or to HART-CT. Tumour regression grade was postoperatively assessed according to the 4-point scale as recommended by the American Joint Committee on Cancer (AJCC). The secondary endpoints included overall survival (OS), disease-free survival (DFS), toxicity of preoperative treatment, locoregional, and distant failure rates. There were 187 patients eligible for analysis: 95 in HART and 92 in the HART-CT. Median follow-up was 5.6 years.</p><p><strong>Results: </strong>The analysis demonstrated a significantly higher chance of achieving pathologic complete response in HART-CT arm: complete response was achieved in 4/95, 4% (HART) and 11/92, 12% (HART-CT) (P = .045). The differences in OS and DFS, while tending to favour HART-CT, were not significant: OS (P = .13, hazard ratio [HR] = 0.82, 95% CI, 0.63-1.06) and DFS (P = .32; HR = 0.88, 95% CI, 0.69-1.13). The locoregional failure and distant metastases rates did not statistically differ between the trial arms. The rate of late complications was similar (P = .51), grade 3+ being 8% versus 11% in the HART/HART-CT group, respectively.</p><p><strong>Conclusions: </strong>The hyperfractionated preoperative radiotherapy with concurrent 5-Fu-based chemotherapy (HART-CT) improved pathological response rate compared to HART. This translated into favourable OS and DFS in HART-CT, but the differences did not reach the threshold for significance.</p><p><strong>Advances in knowledge: </strong>A new hyperfractionated chemo-RT scheme is proposed. Histopathological major response (TRG 0-1) is associated with better clinical outcome.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1879-1889"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of clinical outcome and predictors of mortality in patients undergoing antegrade transvenous variceal embolization in adjunct to salvage transjugular intrahepatic portosystemic shunt for active uncontrolled gastric variceal bleeding.","authors":"Yashwant Patidar, Navojit Chatterjee, Amar Mukund, Shiv Kumar Sarin","doi":"10.1093/bjr/tqae141","DOIUrl":"10.1093/bjr/tqae141","url":null,"abstract":"<p><strong>Objectives: </strong>Salvage transjugular intrahepatic portosystemic shunt (TIPS) is indicated in patients with active endoscopically uncontrollable variceal bleeding. TIPS alone is not effective in the management of gastric varices, and balloon occluded transvenous obliteration (BRTO) requires favourable variceal anatomy. Concomitant placement of a TIPS stent with antegrade variceal embolization leads to control of gastric variceal bleeding with no significant increase in portal pressure.</p><p><strong>Methods: </strong>A single-centre retrospective observational study in which patients with active uncontrollable gastric variceal bleeding were included. Technical success of the procedure, 5-day rebleeding, 6-week, and 6-month survival, as well as other additional outcomes, were evaluated.</p><p><strong>Results: </strong>A total of 18 patients were included in the study. Technical success was 100% and significant non-target embolization was seen in 0% of patients. The 6-week and 6-month survival rates were 66.67%, with an overall survival of 108.786 days (censored at 180 days). The 5-day rebleed rate was 11.1%. A significant difference in Child-Turcotte-Pugh score (P = .03), model for end-stage liver disease-sodium (MELD-Na) score (P = .022), requirement of intubation (P = .038), haemoglobin (Hb) levels (P = .042), haematocrit value (P = .018), packed red blood cell infusion required prior to and after the procedure (P = .045, .044), and presence of refractory shock (P = .013) was observed between the survival and the mortality groups. Post-variceal bleeding Hb levels, mean arterial pressure, and MELD-Na scores were significant predictors of mortality.</p><p><strong>Conclusion: </strong>TIPS in adjunct to antegrade transvenous embolization is a safe and effective modality for the management of active uncontrolled gastric variceal bleeding in patients with variceal anatomy unfavourable for performing retrograde obliteration.</p><p><strong>Advances in knowledge: </strong>(1) TIPS alone may not be effective in the management of gastric varices. BRTO requires favourable variceal anatomy and may lead to catastrophic oesophageal variceal haemorrhage. Concomitant placement of a TIPS stent with antegrade variceal embolization leads to control of gastric variceal bleeding with no significant increase in portal pressure. (2) TIPS, in conjunction with antegrade transvenous embolization, requires proper knowledge of variceal anatomy and the embolizing agent. Post-variceal bleeding Hb levels, mean arterial pressure, and MELD-Na scores were significant predictors of mortality.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1791-1798"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Applications of Photon-Counting CT.","authors":"Khanin Khanungwanitkul, Olga Sliwicka, Fides Regina Schwartz","doi":"10.1093/bjr/tqae206","DOIUrl":"https://doi.org/10.1093/bjr/tqae206","url":null,"abstract":"<p><p>Photon-counting computed tomography (PCCT) has shown promising advancements in abdominal imaging in clinical use. Though more peer-reviewed primary literature is needed, this commentary explores PCCT's potential applications, focusing on enhancing diagnostic accuracy, optimizing radiation dose management, and improving patient care. PCCT offers improved spatial and contrast resolution, lower image noise, and reduced radiation dose. Increased spatial resolution provides better detail in abdominal imaging, aiding in the detection of small lesions and subtle pathological changes. However, this generates more images per scan, raising concerns about \"image overload\" in PACS, potentially leading to longer reading times and increased stress for radiologists. PCCT's improved contrast resolution enhances tissue differentiation, reducing the need for intravenous contrast agents. The technology's advanced tissue characterization provides several advantages, such as non-invasive and opportunistic liver disease evaluation and improved differentiation of renal and adrenal masses. PCCT's optimized radiation dose management is crucial for patients requiring frequent scans. Enhanced diagnostic accuracy through spectral information aids in tissue differentiation, improving confidence in diagnoses. Streamlined workflows, particularly in emergency settings, and oncologic imaging, are potential benefits, reducing the need for additional imaging studies. Future integration of PCCT into clinical practice requires collaboration, education, and research to fully harness its potential, ensuring optimized abdominal imaging and improved patient care.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving SPECT-CT technology.","authors":"Kathy P Willowson, Dale L Bailey","doi":"10.1093/bjr/tqae200","DOIUrl":"https://doi.org/10.1093/bjr/tqae200","url":null,"abstract":"<p><p>Both hardware and software developments have seen single photon emission computed tomography (SPECT)/X-ray computed tomography (CT) technology grow at a rapid rate. Such growth has been fuelled by the need for clinical applications and has provided inspiration for clinical developments, particularly with the expanding role of theranostics. Developments such as whole-body quantitative reconstructions, digital detectors, and recent multidetector 3D geometry have allowed SPECT to become comparable to PET on a number of fronts, with a particularly powerful role in biodistribution and dosimetry studies for both planning and evaluating radionuclide therapy. Whilst there remain fundamental challenges for SPECT such the limited spatial resolution and sensitivity, the unique opportunity to image long-lived radioisotopes and simultaneous multi-tracer studies, together with easily accessible equipment, makes SPECT/CT a valuable clinical asset. This review discusses developments in SPECT/CT technology and their clinical impact.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking at the gender disparity in interventional radiology: a scoping review.","authors":"Courtney Moffitt, Eloise Powell","doi":"10.1093/bjr/tqae137","DOIUrl":"10.1093/bjr/tqae137","url":null,"abstract":"<p><strong>Objectives: </strong>The underrepresentation of women within interventional radiology (IR) is profound. This scoping review aims to evaluate the current literature on gender disparity within IR. To uncover relevant themes and research gaps to inform future research and to recommend changes aimed at increasing application and retention of women in IR.</p><p><strong>Methods: </strong>A review of MEDLINE, EMBASE, and Web of Science was conducted. Specific inclusion and exclusion criteria were used to gather all relevant literature. Thematic analysis of included literature highlighted themes and commonalities between papers.</p><p><strong>Results: </strong>Of 396 articles, only 15 met the inclusion criteria. Many papers were excluded due to their lack of relevance to the topic. Thematic analysis identified 6 themes radiation exposure, mentorship, male dominance, work-life balance, research, and early exposure to IR.</p><p><strong>Conclusions: </strong>Recommendations relating to each theme have been made. Establishing a high-quality mentoring scheme, for medical students, is the priority. Followed by accurate information, regarding radiation safety and teaching opportunities provided by medical schools and placement trusts, to demonstrate the value of IR and the need for a representative workforce.</p><p><strong>Advances in knowledge: </strong>With little research based primarily within the United Kingdom, this review has amalgamated results from papers published internationally to highlight potential factors influencing the gender disparity within IR. Realistic recommendations and future points of research aimed at creating gender parity that are appropriate towards both the United Kingdom and global institutions have been suggested.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1622-1626"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated estimation of thoracic rotation in chest X-ray radiographs: a deep learning approach for enhanced technical assessment.","authors":"Jiuai Sun, Pengfei Hou, Kai Li, Ling Wei, Ruifeng Zhao, Zhonghang Wu","doi":"10.1093/bjr/tqae149","DOIUrl":"10.1093/bjr/tqae149","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to develop an automated approach for estimating the vertical rotation of the thorax, which can be used to assess the technical adequacy of chest X-ray radiographs (CXRs).</p><p><strong>Methods: </strong>Total 800 chest radiographs were used to train and establish segmentation networks for outlining the lungs and spine regions in chest X-ray images. By measuring the widths of the left and right lungs between the central line of segmented spine and the lateral sides of the segmented lungs, the quantification of thoracic vertical rotation was achieved. Additionally, a life-size, full body anthropomorphic phantom was employed to collect chest radiographic images under various specified rotation angles for assessing the accuracy of the proposed approach.</p><p><strong>Results: </strong>The deep learning networks effectively segmented the anatomical structures of the lungs and spine. The proposed approach demonstrated a mean estimation error of less than 2° for thoracic rotation, surpassing existing techniques and indicating its superiority.</p><p><strong>Conclusions: </strong>The proposed approach offers a robust assessment of thoracic rotation and presents new possibilities for automated image quality control in chest X-ray examinations.</p><p><strong>Advances in knowledge: </strong>This study presents a novel deep-learning-based approach for the automated estimation of vertical thoracic rotation in chest X-ray radiographs. The proposed method enables a quantitative assessment of the technical adequacy of CXR examinations and opens up new possibilities for automated screening and quality control of radiographs.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1690-1695"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-contrast abbreviated MRI for the detection of hepatocellular carcinoma in patients with Liver Imaging Reporting and Data System LR-3 and LR-4 observations in MRI.","authors":"Soe Thiha Maung, Natthaporn Tanpowpong, Minchanat Satja, Sombat Treeprasertsuk, Roongruedee Chaiteerakij","doi":"10.1093/bjr/tqae140","DOIUrl":"10.1093/bjr/tqae140","url":null,"abstract":"<p><strong>Background and aims: </strong>With ultrasound sensitivity limited in hepatocellular carcinoma (HCC) surveillance and few prospective studies on non-contrast abbreviated MRI (NC-AMRI), this study aimed to assess its diagnostic performance in detecting HCC.</p><p><strong>Methods: </strong>This prospective study involved cirrhotic patients with contrast-enhanced MRI (CE-MRI) Liver Imaging Reporting and Data System (LI-RADS) LR-3 and LR-4 observations detected during HCC surveillance. Patients underwent average 3 complete CE-MRI rounds at 3-6 months interval, with approximately 12-month follow-up. NC-AMRI included diffusion-weighted (DWI), T2-weighted imaging (T2WI), and T1-weighted imaging (T1WI). NC-AMRI protocol images were analysed for diagnostic performance, with subgroup analyses. CE-MRI and NC-AMRI images were independently reviewed by 2 experienced radiologists, with inter-reader agreement assessed with Kappa coefficient. The reference standard was the American Association for the Study of Liver Diseases-defined presence of arterial hypervascularity and washout during the portal-venous or delayed phases on CE-MRI.</p><p><strong>Results: </strong>In 166 CE-MRI follow-ups of 63 patients (median age: 63 years; 60.3% male, 39.7% female), 12 patients developed HCC, with average size of 19.6 mm. The NC-AMRI (DWI + T2WI + T1WI) showed 91.7% sensitivity (95%CI, 61.5-99.8) and 91.6% specificity (95%CI, 86.0-95.4), area under receiver operating characteristic 0.92 (95%CI, 0.83-1.00). Across different Body Mass Index categories, lesion size, Child-Turcotte-Pugh classes, Albumin-Bilirubin (ALBI) grades, and Model for End-Stage Liver Disease classes, sensitivity remained consistent. However, specificity differed significantly between ALBI grade 1 and 2 (86.7% vs. 98.4%, P = .010), and between viral and non-viral cirrhosis (93.8% vs. 80.8%, P = .010).</p><p><strong>Conclusions: </strong>NC-AMRI proved clinically feasible, and exhibits high diagnostic performance in HCC detection.</p><p><strong>Advances in knowledge: </strong>This study highlights efficacy of NC-AMRI in detecting HCC among cirrhotic patients with LR-3 and LR-4 observations, representing significant progress in HCC surveillance.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1671-1682"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A dual-center study: can ultrasound radiomics differentiate type I and type II epithelial ovarian cancer patients with normal CA125 levels?","authors":"Lixuan Chen, Chenyang Jin, Bo Chen, Asta Debora, Weizeng Su, Qingwen Zhou, Shuai Zhou, Jinyan Bian, Yunjun Yang, Li Lan","doi":"10.1093/bjr/tqae144","DOIUrl":"10.1093/bjr/tqae144","url":null,"abstract":"<p><strong>Objective: </strong>CA125 is recommended by many countries as the primary screening test for ovarian cancer. But there are patients with ovarian cancer having normal CA125. We hope to identify the types of EOC with normal CA125 levels better by building a refined model based on the ultrasound radiomics, thus providing precise medical treatment for patients.</p><p><strong>Methods: </strong>We included 58 patients with EOC with normal CA125 from 2 centres, who were confirmed by preoperative ultrasound and pathology. We extracted 1130 radiomics features based on the tumour's region of interest from the most typical ultrasound image of each patient. We selected radiomics and clinical features by LASSO and logistic regression to construct Rad-score and clinical models, respectively. Receiver operating characteristic curves judged their test efficacy. On the basis of the combined model, we developed a nomogram.</p><p><strong>Results: </strong>Area under the curves (AUCs) of 0.93 and 0.83 were achieved in both the training and test groups for the combined model. There were similar AUCs between the Rad-score and clinical models of 0.82 and 0.80, respectively. By analysing the calibration curves, it was determined that the nomogram matched actual observations in the training cohort.</p><p><strong>Conclusion: </strong>Ultrasound radiomics can differentiate type I and type II EOC with normal CA125 levels.</p><p><strong>Advances in knowledge: </strong>This study is the first to focus on EOC cases with normal level of CA125. The subset of patients constituting 20% of the disease population may require more refined radiomics models.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1706-1712"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and results of cryoablation for the treatment of early breast cancer in non-surgical patients.","authors":"Lucía L Graña-López, Laura L Abelairas-López, Ignacio I Fernández-Sobrado, Sabela S Verea-Varela, Ángeles A Villares-Armas","doi":"10.1093/bjr/tqae131","DOIUrl":"10.1093/bjr/tqae131","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate acceptance of percutaneous cryoablation (PCA) treatment by patients with early breast cancer (BC) who choose not to have surgery and present our experience in the use of PCA for the local control of BC in this group of patients.</p><p><strong>Methods: </strong>All biopsy-proven early BC diagnosed in our institution as non-surgical patients between January 2020 and December 2023 were retrospectively reviewed. We recorded if PCA was offered and if it was accepted by the patient. PCA was performed under ultrasound (US) guidance, using a liquid nitrogen-based system. Mammography and US or contrast-enhanced mammography follow-up was scheduled every 6 months for 5 years. Patient's tolerance to the procedure, adverse effects, and results regarding local control of the disease were assessed.</p><p><strong>Results: </strong>A total of 66 early BC were diagnosed in 63 patients who decided not to have surgery. Median age was 88 years (range 60-99 years). Forty-three (95.6%) of the 45 patients offered PCA accepted. Thirty-nine malignant tumours (median size 24 mm) underwent PCA. All cases were previously reviewed in a multidisciplinary tumour board. Complete tumour necrosis was achieved in 81.3% of the cases followed for ≥ 6 months. After a median follow-up of 16 months, the complete ablation rate in Luminal BC ≤ 25 mm was 100%. No major complications were seen.</p><p><strong>Conclusions: </strong>Non-surgical patients with early BC accepted PCA when the treatment was offered. PCA is safe, effective, and well-tolerated outpatient procedure. The study outcomes suggest that PCA could be an alternative to surgery for the management of BC in this group of patients.</p><p><strong>Advances in knowledge: </strong>Patients with early BC who choose not to have surgery accept PCA. This percutaneous approach probably allows local control of early BC, mainly in ≤25 mm Luminal tumours.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1713-1723"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of contrast-enhanced mammogram as an adjunct to tomosynthesis in evaluation of circumscribed breast lesions.","authors":"Dharmalingam Porkodi, Jagannathan Devimeenal","doi":"10.1093/bjr/tqae130","DOIUrl":"10.1093/bjr/tqae130","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the role of contrast-enhanced mammogram (CEM) in the characterization of circumscribed lesions detected in digital breast tomosynthesis (DBT) and correlated with histopathology.</p><p><strong>Methods: </strong>A retrospective study was done on 205 circumscribed breast masses detected with DBT and for whom CEM was done before core biopsy/excision biopsy. Morphology of lesion enhancement was noted at a 2-min CEM image and depending on the enhancement pattern, they were classified as benign, malignant, and indeterminate. Indeterminate lesions were further characterized by contrast kinetics at 8 min and divided into benign and malignant lesions. The results were correlated with histopathology reports.</p><p><strong>Results: </strong>Among the 205 lesions, 158 were benign and 47 were malignant by histopathology. All 47 malignant cases were diagnosed as malignant (sensitivity-100%) and 150 out of 158 benign lesions were diagnosed as benign by CEM (specificity-95%). Eight benign lesions were reported as malignant (false positive) by CEM. Positive predictive value was 85.4% (47/55); negative predictive value (NPV) was 100% (150/150); accuracy was 96% (197/205).</p><p><strong>Conclusions: </strong>The high sensitivity of CEM in our study suggests that CEM helps in the early diagnosis of benign-looking circumscribed breast malignancies. The high NPV of CEM helps to avoid unnecessary biopsies and interventions in benign lesions.</p><p><strong>Advances in knowledge: </strong>This study describes the contrast enhancement pattern of benign and malignant circumscribed breast lesions and thereby helps in the diagnosis of malignancy at an early stage. CEM is a promising adjunct tool since it offers functional imaging as a supplement to anatomical imaging by DBT.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"1696-1705"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}